Tγδ Cells and their Subsets in Blood and Synovial Tissue from Rheumatoid Arthritis Patients

We have examined the frequencies of T gamma delta cells in blood, synovial fluids, and synovial membranes of patients with rheumatoid arthritis (RA) and in blood from age-matched controls. Immunocytochemical and immunohistochemical techniques were used with monoclonal antibodies BB3 and A13 to define a major and minor blood subset of T gamma delta cells respectively. Together, these antibodies identify the majority (if not all) of the peripheral blood T gamma delta cells. Significantly lower levels of T gamma delta cells were found in the blood of RA patients compared with controls, whilst higher but not significant numbers were found in the synovial fluids of paired samples. Scattered T gamma delta cells were found only in some synovial membranes with a distribution similar to the T alpha beta cells. Analysis of the two different T gamma delta-cell subsets indicated a ratio of BB3 to A13 of about 5:1 in control and RA blood. However, this ratio was less than 1:1 in the RA synovial fluids and membranes. The migratory nature of the A13+ cells could account for their predominance in these sites. The possible pathological significance of these cells in the rheumatoid synovial fluid and synovial membranes is discussed.     

Interaction Between Accessory Pathways Resulting in Inability to Induce Reciprocating Tachycardia

A 44-year old male with Wolff-Parkinson-White syndrome presented with atrial fibrillation. The patient was found at the electrophysioiogical study to have two accessory pathways, one concealed and the other conducting exclusively in the anterograde direction. After radiofrequency catheter ablation of the anterograde conducting pathway, orthodromic reciprocating tachycardia, which previously could not be induced despite an aggressive protocol, was easily induced. Ablation of the concealed pathway resulted in termination of the tachycardia and suppression of inducibility. We propose that interaction between the two accessory pathways resulted in an inability to induce reciprocating tachycardia.     

Lack of awareness of Hepatitis B screening and vaccination in high-risk groups

Background/aim Hepatitis B virus (HBV) vaccination rates are insufficient in high-risk patients worldwide. This study aimed to investigate the screening, immunization, and vaccination rates in three high-risk groups for HBV infection: allogeneic hematopoietic stem cell transplantation (AHSCT), renal transplantation (RT), and chronic hepatitis C (CHC) groups. Materials and methods The serological data of consecutive patients between 2014 and 2019 were reviewed using the hospital database. Results The HBV screening rates were 100.0%, 90.4%, and 82.4% in the AHSCT, CHC, and RT groups, respectively (p = 0.003). The immunization rates against HBV through either previous exposure or vaccination were 79.5%, 71.7%, and 46.5% in the AHSCT, RT, and CHC groups, respectively (p < 0.001). The HBV vaccination rate was significantly low in the CHC group (71.5%, 69.0%, 34.6% in the AHSCT, RT, and CHC groups, respectively, p < 0.001). If patients lost their immunity due to immunosuppressive therapy were accounted, the vaccination rates increased to 95.2% in the AHSCT group and 72.9% in the RT group. The rate of annual screening for HBV status was 97.9% in the AHSCT group, but it was only 23.9% in the RT group. Conclusion HBV screening and vaccination rates were significantly lower in the RT and CHC groups than in the AHSCT group.     

The competence of certified nurse assistants caring for persons with dementia diseases in residential facilities

In Sweden, a majority of elderly persons living in residential facilities have some form of dementia, and caring for them is a demanding and complex task. The formal education level of personnel in residential facilities is low. The aim of this paper is to describe certified nurse assistants' (CNAs) content of competence caring for persons with dementia diseases in residential facilities. Information from 22 diary notes was obtained and 12 CNAs in four residential facilities were interviewed. The diary notes and interviews were transcribed and analysed using conventional content analysis. Three main categories were generated from the diaries: Social and Health Care, Health Care Targeted towards Medicine and, finally, Organization. The same categories were generated from the interviews but with the addition of Knowledge – its use, growth and deficiencies. The results show that competence is mainly based on personal, experienced-based knowledge and 'standard routines'. In general, the nurse assistants' interest in developing knowledge is weak. Furthermore, CNAs lack competence in essential theoretical knowledge about dementia diseases. It is notable that CNAs, caring for people with serious dementia, know little about the reasons for the residents' divergent behaviour. Consequently, knowledge related to dementia and mental diseases must be highlighted. Therefore, formal education focused on these diseases is crucial.     

Radiofrequency Modification of Atrioventricular Conduction by Selective Ablation of the Low Posterior Septal Right Atrium in a Patient with Atrial Fibrillation and a Rapid Ventricular Response

A case is presented of a 58-year-old woman with atrial fibrillation and uncontrolled ventricular responses up to 180 beats/min despite therapy with digoxin. Radiofrequency energy was applied to the low posteroseptai right atrium in an attempt to modify "slow fiber" conduction. This resulted in a decrease in ventricular rate from 125 to 50 beats/min. Follow-up Holter monitor demonstrated an average heart rate of 64 beats/min (range 43–112). On exercise tolerance test, the maximum heart rate was 126. Modification of the low posterosepta right atrium may prove to be an alternative to AV node or His bundle ablation and pacemaker implantation in patients with poorly controlled atrial fibrillation and rapid ventricular response. The mechanism by which this approach was effective may be ablation of slow conducting AV nodal fibers with a short refractory period.     

"LONG-TERM" SURVIVAL IN LIGHT-CHAIN MYELOMA WITH DIALYSIS THERAPY ALONE

We report a case of a 59 year old woman who presented in end-stage renal failure with lambda (A) light-chain myeloma (LLCM). Despite a large tumour burden, and refusal to accept cytotoxic chemotherapy, she was commenced on continuous ambulatory peritoneal dialysis (CAPO). With dialysis therapy alone she has shown considerable hematological improvement and remains well 18 months after diagnosis. The extremely poor prognosis attributed to light-chain myeloma is largely due to death from uremia. As the natural history of this disease in patients offered dialysis therapy is unknown, dialysis should not automatically be withheld from patients with LLCM.